Prescription drug abuse in the U.S. is now causing more deaths than that of heroin and cocaine combined. Many agencies have come up with strategies including the development of continuous programs that medically educate consumers and health care providers. These programs require ongoing training and certification before they can prescribe specific drugs.

Agencies are also coming up with curriculum resources to help future prescribers stay on top of the situation, according to the report. The Office of National Drug Control Policy is further coming up with legislation that will require education for those prescribers who register with the Drug Enforcement Administration (DEA) in order to prescribe such controlled substances.

The General Accountability Office (GAO) said the agencies did vary with how they used key practices as they were developing their efforts. Their efforts did vary in duration, scope and size but all agencies did establish ways to monitor certain elements of their efforts to educate the public. Only two of the agencies have already established or are currently seeking plans to establish ways to assess the influence of their work on audiences’ attitudes, behavior and knowledge.

The GAO says without these evaluations, federal agencies have little knowledge about the effectiveness of their attempts to reduce prescription painkiller misuse.

In the recent study, the researchers tested 20 patients who were instructed to photograph the capsule in their hand and then email the picture to the researchers. The photographs on the cell phones were then compared to other approaches in order to better assess proper intake of these medications.

The first method known as a medication event monitoring system, or MEMS, contains a pill bottle that electronically monitors each time the pill bottle is opened up. The second method is the pill count. Researchers monitor the patient’s number of capsules with each doctor visit when they come in to refill their capsules.

With the MEMS method, the rate of compliance was 95 percent; the pill count method was 94 percent. The cell phone method was least effective showing only 77 percent adherence and underestimated compliance. MEMS, however, tended to overestimate its compliance rate, compared with the pill count approach. With the cell phone pictures, the time stamp method showed patients had higher compliance rates when they took their meds at the same time each day.

Patients in this study received a small monetary incentive for sending photos from their cell phones, but there were some problems with lost phones and extra Internet charges. This is a challenging problem for the medical community and researchers are still searching for the most effective method to best aid in treatment.

Dentists are not aware of their contribution to the problem of opioid abuse in the U.S., says the author of a study highlighted in Medical News Today. At times these dentists do not know the proper number of doses to prescribe to patients or what to do with leftover pills. Leftover prescriptions often become the source for children and young adults to attain pills because they aren’t getting thrown away or disposed of properly.

Dentists are third in line to prescribe the most opioids with instant release ability in the country. George Kenna, assistant professor at Brown University for Warren Alpert Medical School, says that many dentists haven’t even realized there is a problem with prescribing the opioids. Kenna is a pharmacist as well and says that painkillers like oxycodone and others often become a source of drugs in households due to the leftover problem and lack of proper training for dentists and pharmacists. Seven out of every ten people who have used these painkillers acquired them through a friend or member of their family and had acquired them nonmedically.

A program on Risk Management of Opioids led by Kenna and other dentists and experts on addiction came up with several recommendations for dentists to help reduce this problem. The group of experts and pharmacists stated a need to write smaller quantities and limit the amount of refills and to simply not prescribe painkillers to those you do not know. Prescribers should also be leery of those who say their pills were stolen or have been lost. The authors of the article say they need more research to decide how to best meet patient needs without furthering the problem.

Those offering treatment to addicts confirm the problem as they also report sharply higher instances of prescription drug misuse. In fact, drug treatment centers in the state of New York announced that the number of crisis admissions for treatment which were connected to scheduled drugs doubled between 2007 and 2010 while non-crisis admissions went up 65%. Perhaps it should not come as a surprise given the fact that prescriptions written for addictive medications have risen a stunning 153% over the past 10 years. Prescriptions in New York for the drug oxycodone alone have multiplied by 50% since 2008 and in Albany County, it has become the 4th most prescribed drug.

Currently, New York State requires pharmacists to keep a record with the State Department of Health each time a narcotics prescription is filled. Unfortunately pharmacists have no way to know if the person has previously filled the prescription at another pharmacy. It wasn’t until this past February that physicians were allowed access to this information. With the current system, once it is determined a patient is abusing prescriptions for scheduled drugs, a letter is sent to doctors making them aware of the behavior. The system, in its present form, is encumbered by a lag of one month between the time the pharmacist reports and the time the information is snail-mailed to physicians.

To remedy the situation and hopefully provide more timely intervention, a bill was recently proposed from the office of the New York State Attorney General. The bill proposes to block a person’s ability to obtain the illicit drugs through an Internet System for Tracking Over-Prescribing or I-STOP. Under the proposal, doctors and pharmacists would each be required to check a patient’s prescription history every time they write or fill a prescription for a narcotic. The I-STOP system overcomes the gap in the current system between the time information is entered and the time it is accessed. Instead, I-STOP would provide up-to-the minute data that could prevent prescriptions from ever being written for abusers.

The proposed bill carries stiff penalties for non-compliant doctors or pharmacists. Under the bill both doctors and pharmacists would receive a $500 fine the first time they fail to either review or report prescription database information, or if they share private patient information with a third party. Multiple offenses carry fines of up to $5,000.

In the face of a national addiction phenomenon and regional addiction/overdose worries involving prescription medications, New York is joining other states in the country looking for a way to address the crisis. I-STOP promises to provide real-time data to curb over-prescribing, to identify addicts in order to direct them to proper treatment and to halt prescription drug trafficking.

The five-year federal plan to reduce prescription drug abuse in the U.S. is getting approval from several expert organizations, such as the American Psychiatric Association, physicians groups and groups like the Academy of Addiction Medicine.

Statements of support from these organizations and others have been sent as part of a cooperative strategy to combat prescription drug addiction and abuse, created by the Office of National Drug Control Policy at the White House. Additional partners on the plan are the Food and Drug Administration, the U.S. Department of Health and Human Services and the Drug Enforcement Administration.

The expanded efforts toward physician, pharmacist and patient education are among measures organizations are approving, according to a Medscape Today article. Under the new plan, physicians and providers will complete educational courses on how to administer pain medication and how to monitor patients’ usage. Other measures address ways to teach people to properly throw away unused prescriptions, the closing of pill mills and using tools like databases to monitor patients who move from doctor to doctor or pharmacy to pharmacy to get their pain medication prescriptions.

Emergency room visits related to overdoses from prescription drugs grew twofold in the five-year span from 2004 to 2009, exceeding 1.2 million visits. Proponents of the federal plan hope physicians will understand that new levels of regulations will be put into place for doctors who prescribe the drugs, especially opioid-based formulas, even if they’ve been prescribing pain medications for years. However, to renew their licenses, many doctors must already complete additional education or training in their state, and the requirements from the federal plan aren’t likely to require a significantly larger investment of resources or time.

While the level of educational hours doctors will be asked to complete for prescribing pain medications is still unknown, it could include two to eight hours, with additional ongoing courses offered. Calling the nation’s prescription drug abuse problem at crisis-level, policymakers and medical organizations are hopeful that the federal plan will make a positive impact.

Actually, there may be some that you’ll want to get rid of sooner than others. Still, how do you do so in the most efficient and safe manner? Believe it or not, there are right ways and wrong ways to dump your old meds. Here are some tips from the experts.

Round Up All Meds and Analyze

The first step in properly disposing of unwanted or no longer usable prescription medications is to gather them all in one place and take an inventory and analyze. What you’re looking for are expiration dates (any that are already expired are no good to anyone and need to be disposed of), warnings (some medications may have special disposal instructions), name, type, and dosage.

Why is all this important? You need to understand what you’re dealing with. Even more important, you don’t want to inadvertently toss out or dispose of medication that you still need to take. This may happen when someone arbitrarily decides that they don’t want to take meds any longer, and they just pitch everything in the trash or flush it down the sink. Not only is this practice hazardous to others, it also jeopardizes the individual. There could be a gap in medication use that may be quite harmful or cause unwanted rapid-onset withdrawal symptoms.

Maybe you’re not quite sure about some medications that you haven’t taken for a while at the direction of your doctor. They haven’t reached their expiration date and your doctor may have you on a different medication or different dosage as a trial to see which medication works better for you. This is often the case with prescribed drugs to help control symptoms of depression, anxiety, bipolar disorder, schizophrenia or other mental health disorders.

The best way to proceed is to make a complete list of all the medications. Write down the name of the medication, the dosage, how frequently taken, who it is prescribed for, and for what purpose. Also write down the prescribing doctor’s name, prescription number, and expiration date of the medication. Now you have a complete inventory and can proceed to the next step.

Contact Your Doctor

Remember that you never want to just get rid of prescription medications that your doctor ordered for your care without first talking with the physician to ensure that such medications are no longer needed. Even if you really want to stop taking them, you are not your best counsel – and you’re certainly not a doctor (in most cases, but even doctors aren’t always the best judge of what’s the right course of action when it comes to their own health).

Call your doctor or make an appointment and go in with your list of medications. Have a candid discussion about your desires and ask when and if you are ready to stop taking certain drugs. You may be concerned about side effects, or feel that you no longer need the drugs or that they’re not working properly. These are things that you should be discussing with your doctor on an ongoing basis, but many people neglect to do so following treatment. Granted there are a lot of things occupying your time when you are in recovery, but taking care of your health and seeing your doctor and therapist regularly are right up there in importance – at least they should be.

If your doctor concurs that you can begin to stop taking certain medications, circle or highlight those with bright or bold marker so you know exactly which ones are okay to discontinue. The ones you don’t circle are the ones you still need to take. Remember that you can’t just stop taking some drugs cold turkey. This action may precipitate nasty withdrawal or even life-threatening reactions. Your doctor may need to prescribe a different medication or one of stepped-down dosage in order to safely wean you off the medication. Always be guided by your doctor’s recommendations and follow them as directed.

Safeguard Medications that are Still Required

While you are preparing to dispose of medications that your doctor has agreed you no longer need, it’s also important that you safeguard all medications that you are still supposed to take. This means locking them up, keeping them out of reach of children or others who may take them by accident or on purpose.

Many instances of unintended poisoning occur each year because people fail to secure prescription – and over-the-counter (OTC) – medications. This is a tragedy that is totally preventable. Just install a lock on a medicine cabinet or place prescription medications in a lockable credenza, drawer, or other storage area. Be sure that the temperature in the location doesn’t exceed what is recommended for safe storage however, since extreme heat or cold may cause the medication to deteriorate and lose effectiveness.

Why Not Flush Meds Down Plumbing?

Sad to say, far too many people think the simplest and safest way to get rid of unwanted prescription medications is just to flush them down the plumbing, either a sink or a toilet. This is extremely hazardous for a number of reasons. Chief among them is the fact that sewage plants are designed to treat biodegradable organic waste, not pharmaceuticals. The chemicals that are in the consumer products (prescription medications) can and do slip past the treatment and stay in the effluent that then spills out into lakes, rivers, streams, and oceans. In addition, the contaminated material may also make its way into the heavy sludge that is used as landfill cover or in farmland fertilizer.

Various studies of fish have shown a number of reproductive abnormalities caused by medications flushed into waterways. Such medications range from concentrations of endocrine-disrupting chemicals from birth-control pills to toxic reactions from many other kinds of prescription medications. Flushing medication down plumbing has another unintended effect. It may wind up in your community’s water supply – and create potentially serious health problems for others.

Don’t Toss Meds in the Garbage

Another no-no when it comes to disposing of most old or unwanted prescription medication post-treatment is tossing it in the garbage. The worst danger is that children or pets can get into the trash and ingest the medication accidentally – with potentially fatal results.

Another reason not to toss meds in the garbage is that despite the fact that many medications are still in prescription containers, such medication may eventually make its way into the soil in landfills. This can create an environmental hazard.

Some people believe – and it was long considered safe – that they can just pulverize the medications, place the powder back in the original prescription containers, wrap in several layers of thick zip-lok bags or plastic containers and then throw out in the trash. While plastic doesn’t degrade quickly (or at all), it doesn’t help landfills, And the problem again with this method is that there’s no guarantee the hazardous material won’t leak or somehow make its way into the soil or groundwater.

If you can’t flush these meds down the plumbing or toss them in the garbage, how can you safely dispose of them?

Safe Medication Disposal Suggestions

You have a few choices when it comes to the safest ways to dispose of unwanted or unusable prescription medications.

1. Check the instructions included with your prescriptions or medication labeling. Always check the instructions for proper disposal of medications that are included with your prescription or on the product labeling.
2. Contact your pharmacy. Call the pharmacy where your prescription was filled. They may be able to take back the medication and safely dispose of it for you or they may give you a referral to an organization that provides this service. Some pharmacies advertise or will tell you if you ask about their drug recycling programs. Some pharmacies will take back drugs at any time, while others may only accept drugs for disposal at certain predetermined times during a period drive to collect expired medications. If the first pharmacy you call either doesn’t have a drug recycling program or doesn’t have any recommendations for, contact another pharmacy. You’ll eventually find one that will be able to help.
3. Ask if your doctor takes back medication. Some doctors may offer this service, but many more will not. Just as some pharmacists will have "take back medication days," some doctors may wish to provide such a service to their patients. If you don’t already know whether or not your doctors will do so, contact his or her office to find out for sure.
4. Check your city for organized safe medication disposal days. Some cities and communities have annual or semi-annual organized safe medication disposal days. Often these organized disposal days list numerous hazardous or potentially hazardous materials – including prescription medications – that you can bring to a central location on a given date for proper disposal.
5. Check with your trash disposal service. Since expired medication is considered a hazardous waste, your trash disposal service may offer collection at certain times. This is often published in flyers that arrive with your trash disposal bill or appear as a notice in the local newspaper.
6. Check websites. If your city or town has a website, or if your local trash disposal service has a website, check them to find out about hazardous waste disposal. Specifically look for medications in the listing of types of hazardous materials that will be disposed of or how to properly dispose of medications. If nothing is listed, contact the city, town, or trash disposal service for recommendations.
7. Donate to organizations that accept unexpired medication for use in third-world countries. Finally, there are some organizations that accept certain medications that have not yet expired for use in third-world countries. And, in some cases, even though the medication may be expired, such organizations may be able to utilize some of them – since expiration date is a generalized time-frame and some medications remain usable well beyond printed expiration date. Only a professional can determine this, however, so don’t guess about it. Contact the organization either through their website or by telephone (often, a toll-free number will be listed).

Remove Personal Identification from Medication Containers

Before you take unwanted or unusable medication to a disposal site or service, or donate to an organization, be sure to safeguard your privacy by removing any personally identifiable information from the container. Use a heavy black marker to darken the area that has your name, and that of your doctor. If the medication is to be disposed of, also blacken out the name of the prescription drug and dosage strength. This will prevent potential misuse of the medication by anyone who comes in contact with it.

Never Give Your Prescription Meds to Someone Else

Just because you no longer need or want to take medication that’s been prescribed for you, even if your doctor okays your discontinuing it, never think you can give these meds to someone else – even if they ask you. This is a dangerous practice that can be illegal, especially if you give it to or allow underage minors to obtain it for their own use.

What If There’s No Take-Back Drug Disposal Available?

The Office of National Drug Control Policy
lists guidelines for proper disposal of prescription drugs on its website. There are some prescription drugs that the U.S. Food and Drug Administration (FDA) recommends can be safely flushed. See the FDA website for the most up-to-date list of drugs that can be safely flushed. Note that the list includes the drugs OxyContin and Percocet.

Information about directions on how to safely dispose of specific marketed drugs can be obtained through the DailyMed website. After you search the drug name, disposal information for the specific drug can be found in one of the following sections: information for patients and caregivers, patient information, patient counseling information, safety and handling instructions, or medication guide.

If the prescription drugs are other than those recommended be flushed by the FDA, and no safe drug disposal service or take-back drug program is available, the federal guidelines from the ONDCP and the U.S. FDA include the following:

• Take prescription drugs out of their original containers.
• Mix the drugs with undesirable substances – such as cat litter or used cofee grounds.
• Place the mixture in a disposable container with a tightly-sealed lid, such as an empty margarine tub or cottage cheese container, or a tightly-sealed zip-lok or plastic bag.
• Remove or conceal any personally-identifiable information, either by using black marker or covering with heavy duct tape. This includes your name and prescription number.
• Then place the sealed container and its contents in the trash.

Be Safe, Not Sorry

It may take a little extra effort to properly and safely dispose of post-treatment medications, but doing what’s right is always better than leaving such an imporant task to chance. Learn all you can about the medications you’re taking that your doctor says you can discontinue. When it comes time to dispose of them, do the right thing and get rid of them safely – for all concerned.

Drawing upon the Obama Administration’s National Drug Control Strategy for reducing and preventing prescription drug abuse that was first proposed in May of this year, Kerlikowske reminded the members of the Caucus of the federal government’s responsibility in leading the effort to substantially diminish the nation’s daunting rate of prescription drug abuse and its consequences within five years. The response needed to accomplish this goal, Kerlikowske described, would require the bipartisan collaboration of all members of Congress.

A week prior, Kerlikowske had joined the Substance Abuse and Mental Health Services Administration (SAMHSA) in announcing the organization’s most recent findings on the nation’s prevalence of substance abuse. The latest statistics on substance abuse have dramatically grown in severity compared to previous years as prescription drug misuse, diversion, overdose, and addiction rapidly continue to spread across all socio-demographics and regions of the U.S.

According to SAMHSA’s latest study, the national rate of illicit substance abuse had risen by nearly 1% from 2008 to 2009. The rate of almost all substances of abuse had significantly inclined within the one-year period, particularly among young adults. Within the short time span, nonmedical use of prescription medications had unsurprisingly increased yet again. For 2009, SAMHSA estimates that 5.3 million Americans ages 12 and older are currently abusing prescription medications—an increase of 20% since 2002. Furthermore, the population of prescription drug abusers now surpasses the number of new users in any other class of drugs; of the 2.6 million new drug users in 2009, 2.2 million were prescription drug abusers.

In similar studies published this year, SAMHSA has found that the national rate of treatment admissions for prescription drug abuse had increased by 400% within just four years, and the number of emergency department visits nationwide related to nonmedical use of prescription drugs rose by 111%. Within the last two decades, U.S. prescriptions for opiate medications jumped from 40 million to 180 million; today, one in seven teenagers admits to abusing prescription drugs, and opioid prescription drug misuse is the leading cause of drug-related injuries among adults 65 and older.

For their leading effort in eradicating the nation’s greatest public health problem, Kerlikowske lauded the members of Congress who worked together to create the Congressional Caucus on Prescription Drug Abuse, including Representatives William Delahunt (D–10th MA), Mary Bono Mack (R–45th CA), and Hal Rogers (R–5th KY). Other party members present included Senator Steven Tolman (D–MA), State Representative Jeffrey Perry (R–MA), and William Keating, Democratic candidate for the 10th Congressional District seat in MA.

The Obama Administration’s plan for reducing prescription drug abuse includes increasing prescription drug return, take-back, and disposal programs; expanding and improving prescription drug monitoring programs; helping states eradicate doctor shopping and pill mills; eliminating illegal Internet pharmacies and pain clinics; educating medical professionals about opiate painkiller prescribing; and educating the public on the dangers of prescription drug abuse. With the Republican party’s new pledge to overturn the Obama Administration’s newly instated healthcare reform, one issue in which both sides of the aisle are in agreement on is the need to provide shared procedures, uniform monitoring, information gathering, and public protection against the dangers of prescription drug abuse.

Sources: Cape Cod Times, George Brennan, Keating: Control Prescription Drugs, September 22, 2010

Office of National Drug Control Policy, Obama Administration Official Urges Immediate Action to Reduce Prescription Drug Diversion, Abuse, September 22, 2010

Recently, Massachusetts passed legislation that requires all pharmacies within the state to provide prescription drug lock boxes for sale to the public at their locations. On August 9, Massachusetts State Senate and House of Representatives passed Chapter 283 to the Acts of 2010: An Act Adding Safeguards to the Prescription Monitoring Program and Furthering Substance Abuse Education and Prevention. The legislation is the first of its kind not just for the state of Massachusetts, but the entire U.S. The bill was sponsored by Governor Deval Patrick, Senator Steven Tolman, and the Massachusetts Pharmacists Association. Section 11(b) of the legislation states that all pharmacies that dispense Schedule II, III, IV, or V prescription drugs are required to make purchasable prescription drug lock boxes readily available to consumers in order to encourage the public’s safety efforts when handling over-the-counter and prescription medications.

Prescription drug lock boxes are safe and secure locking mechanisms that cannot be tampered with without extreme force and can only be opened through its combination lock. A combination lock ensures that only the prescribed patient will have access to their prescription medications as intended, and keeps these prescription drugs from falling into the wrong hands, particularly children. Most retailed prescription lock boxes are designed to hold up to four prescription bottles and can fit within the average medicine cabinet.

Prescription drug abuse has become a national epidemic in recent years, with an alarming rate of abuse among adolescents and older adults alike. On June 3, the Center for Disease Control and Prevention (CDC) reported that 20.2% of American teenagers (1 in 5) admit to having illicitly taken a prescription medication one or more times in their lifetime. Furthermore, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 55.9% of prescription drug treatment admissions had illicitly obtained prescription medications from a friend or family member. Pain relievers, tranquilizers, stimulants, and sedatives are all highly potent drugs that can be just as toxic as street drugs when misused.

Teenagers who abuse pharmaceuticals most often obtain the drugs from their own parents’ medicine cabinets. Some teenagers may bring collections of prescription drugs to parties known as ‘pharm parties’ where multiple prescription drugs are shared among peers and often mixed with other substances such as alcohol, marijuana, or even cocaine. SAMHSA reports that the number of emergency room visits related to prescription pain relievers rose from an estimated 144,644 in 2004 to 305,885 in 2008—an increase of 111%. The abuse of opioid pain reliever medications has caused more overdose deaths in the U.S. than heroin and cocaine combined.

Even though pharmaceuticals are intended to help treat illness or alleviate pain, they are often misused for recreational purposes. Many Americans are unaware of pharmaceutical drugs’ potential for abuse, dependency, addiction, and overdose. The prevalence of prescription drug abuse has now become parallel with illicit substance abuse across the nation, affecting Americans of all regions and demographics. Prescription drug lock boxes are an effective tool for combating prescription drug abuse, and puts control right in the hands of parents to help keep their households safe. By mandating the sale of lock boxes, Massachusetts pharmacies are helping residents understand the dangers involved in handling controlled substances.

Source: PR Newswire, New Law Requires Pharmacies in Massachusetts to Carry Rx Lock Boxes, August 18, 2010

Established in 2007 in part by a $150,000 grant from the U.S. Environmental Protection Agency’s Aging Initiative, Maine’s Center on Aging has run a successful state drug mail-back pilot program. Maine’s mail-back program involves prepaid mailing envelopes for consumers in which they can return their unused medications to a central collection location that is owned by the state’s Drug Enforcement Agency. The prepaid envelopes are made available through physicians’ offices, pharmacies, or post offices. The mail-back program ensures the safe disposal of unused medications to authorities who then sort and incinerate the waste. Since the program’s inception, approximately 3,926 envelopes have been returned that contained a total of 2,300 pounds of drugs. Individuals who have participated in the simplistic mail-back program have utilized 42% of the available envelopes distributed throughout public resources.

Prescription drugs—like painkillers (opioids), benzodiazepines, antidepressants, and antipsychotics—are causing more overdoses and more emergency department visits than any other drug of abuse across several states due to recent surges in prescription drug diversion. Unlike illicit substances that are being sold on the street, Americans of all ages are mostly obtaining prescription drugs from friends or family members, either for free or at a price, for their intentional misuse. Pill mills are churning out pain relieving medications daily, and addicts and drug dealers alike are willing to cross state lines to get their hands on the drugs. Other addicts partake in ‘doctor shopping’ by visiting several doctors and pharmacies to gain multiple prescriptions for drugs like OxyContin, Vicodin, or Percocet—or even resort to identity theft or robbery to continue feeding their habit.

Since 2007, several states including Maine began initiating state legislation to manage the return of unused prescription drugs by implementing drug mail-back programs. Not only does the proper disposal of unused medications help the environment by avoiding drug waste from entering water treatment facilities or landfills, but it helps to prevent drugs from falling into the wrong hands. Too often, teenagers are confiscating prescription pain medications right from their parents’ medicine cabinets for recreational use, which can lead to severe consequences. These legal drugs can be stolen from patients and resold on the streets; in the case of prescription drug overdose death, the source of the prescription drugs is held accountable for the drug-induced fatality. The problem of prescription drug abuse is far-reaching, but can also be prevented with community involvement and intervention support.

After the Maine’s legislature acknowledged the success of its pilot drug mail-back program in early July 2010, the state has approved extended funding of the program to continue it for another two years. Besides Maine, states like Iowa, Oregon, Wisconsin, Pennsylvania, Virginia, California, Arkansas, Colorado, Hawaii, New York, and Tennessee have all adopted a form of consumer drug take-back programs or drug return programs with nursing homes and mental health clinics. The new model drug mail-back program is one method of alleviating prescription drug abuse that has exploded into a national health problem within the past decade. Now, advocates from Maine’s health community are urging Congress to adopt Maine’s pilot drug mail-back program for a national platform. Health professionals are citing the success of the Maine program as an effective method of preventing drug diversion and related health consequences, costs, and economic hazards.

Sources: The Portland Press Herald, David Hench, State gets a partner in fighting pill abuse, July 24, 2010

Enviro.BLR.com, Drug Mailback Program Effective, July 1, 2010

On his night shift in a busy emergency room, Dr. Jacob Khushigian inevitably finds a few patients more likely to be hunting for drugs than medical attention.

The guy who claims he has severe abdominal pain doesn’t grimace when sitting up. A woman who recently moved to the area fails to disclose she sees a doctor elsewhere. An ambulance patient complaining of a sore leg and back doesn’t reveal she was turned away by another hospital.

There was a time Khushigian’s hunches took weeks to confirm and required phoning or faxing the attorney general’s office to obtain a patient’s prescription drug information. Nowadays, a computer helps him catch cheaters. But it can only reach so far.

While a state online drug database went into effect last year to thwart addicts who bounce from doctor to doctor to feed a habit or make a small fortune peddling meds, there’s now a push to extend it beyond state lines to snare so-called doctor shoppers and curb drug abuse.

"The whole purpose of this is to have states communicating with one another," said Dr. Laxmaiah Manchikanti, chief
Doctors can be hamstrung in making critical decisions about prescribing painkillers if they aren’t able to find out if patients filled prescriptions elsewhere.

A nationwide network might have helped Michael Jackson’s doctor better monitor the medication he was receiving from multiple doctors.

Dr. Conrad Murray, who was recently charged with involuntary manslaughter in the singer’s death, told police Jackson gave few details when Murray repeatedly asked about Jackson’s medications, according to an affidavit. The Los Angeles County coroner said Jackson was killed by a mix of a powerful anesthetic and a sedative.

Police have searched for information in three states to see if Jackson’s medical history played a role in his June death.

Jackson’s death and those of other celebrities such as former Playboy Playmate Anna Nicole Smith and actor Corey Haim highlight the dangers of prescription drug abuse. More U.S. teens used prescription drugs over any other illicit drug except marijuana, the Office of National Drug Control Policy reported.

Forty states have passed legislation to allow prescription drug monitoring programs, but only 34 are operating.

Under the National All Schedules Prescription Electronic Reporting Act signed by President Bush in 2005, more than $50 million has been appropriated to states for programs where doctors and other authorized users, such as police in some cases, can access patient records.

The law aims to have a coordinated national system, but there are no estimates what that would cost and a majority of the federal money hasn’t been allocated.

Joanee Quirk, who runs Nevada’s prescription monitoring program, said having access to other state databases would help stop those from Southern California or Hawaii who come to Las Vegas or Reno to score Vicodin or OxyContin.

Nevada’s four-year-old program has grown to more than 225,000 patient requests in 2009 from about 155,000 in 2008.

Most prescription monitoring programs are voluntary, but Nevada requires doctors to check a patient’s drug history during a first visit.

"If we took it away the practitioners would have a revolution," Quirk said. "It’s almost like getting a lab test, where the doctors are trying to figure out what is wrong with this person and whether they are trying to get drugs legally."

Some privacy groups are concerned databases could invade patients’ privacy. Virginia’s database was hacked into in April 2009 and millions of electronic records were stolen by a thief still at large.

"There is a significant intrusion into the lives of individuals who are taking these medications legitimately," said Pam Dixon of World Privacy Forum, a nonprofit public interest research group. "There needs to be more restrictions about who can access this information."

The response to having secure, online access to patient records has been overwhelming so far in California. More than 2,300 doctors, pharmacists, physician assistants and registered nurses have used the Web site since September to access more than 134,000 patient reports. The state had averaged about 60,000 requests annually when they received requests by phone or fax.
Katherine Ellis, who runs the database of about 100 million prescriptions, said emergency room doctors would benefit most from a multistate system.

"If there was a way for ER doctors to sign on as they are triaging that patient and see if that person has been doctor shopping, then they may not elect to give them the controlled substances," she said.

Khushigian, 52, who works at Kaweah Delta District Hospital in Visalia in the Central Valley, is glad he no longer has to rely solely on his gut every night. He uses the database two or three times a night to shut down potential abusers.

"When they get caught, there isn’t much they can say," he said.